Irritable bowel syndrome(IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described fr...Irritable bowel syndrome(IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract(medical model) to a more complex multi-symptomatic disorder of the brain-gut axis(biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system(top-down) as well as effects on the intestine through stressors,infection,inflammation,food and dysbiosis(bottom-up) can affect braingut communication and result in dysregulation of the autonomic nervous system(ANS),playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension,movement patterns,and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions,such as fibromyalgia,chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination,including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic cooperation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment,addressing the topic from a practical point of view.展开更多
AIM: To compare irritable bowel syndrome (IBS) pa- tients with apparently healthy persons and to evaluate body awareness therapy, which is a physiotherapeutic remedy focusing on normalising tensions in the body, for t...AIM: To compare irritable bowel syndrome (IBS) pa- tients with apparently healthy persons and to evaluate body awareness therapy, which is a physiotherapeutic remedy focusing on normalising tensions in the body, for the treatment of IBS with the hypothesis that altered body tension is associated with the syndrome. METHODS: Twenty-one IBS patients received body awareness therapy two hours weekly for 24 wk. At base- line as well as after 12 and 24 wk, they underwent ex- aminations including resource oriented body examination in combination with body awareness scale evaluation and f illed in gastrointestinal and psychological symptom questionnaires. Saliva cortisol was analysed. A group of 21 apparently healthy persons underwent the same ex- aminations once. RESULTS: Compared to the apparently healthy group, IBS patients scored higher at baseline for gastrointestinal and psychological symptoms. They showed more often alterations in normal body tension patterns, as well as deviating cortisol slopes in saliva. After 24 wk of body awareness therapy, their gastrointestinal and psychologi- cal symptoms were reduced overall. Somatic symptoms decreased in parallel with depressive symptoms. Whole body pain score decreased, coping ability as well as bio- chemical stress markers improved. CONCLUSION: IBS patients scored higher for gastroin- testinal and psychological symptoms, and presented with altered biochemical stress markers. Their body tension deviated compared to healthy controls. Furthermore,body awareness therapy gave relief of both somatic com- plaints, psychological symptoms and normalised body tension. These findings indicate that distorted tension constitutes an important part of the symptoms in IBS.展开更多
文摘Irritable bowel syndrome(IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract(medical model) to a more complex multi-symptomatic disorder of the brain-gut axis(biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system(top-down) as well as effects on the intestine through stressors,infection,inflammation,food and dysbiosis(bottom-up) can affect braingut communication and result in dysregulation of the autonomic nervous system(ANS),playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension,movement patterns,and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions,such as fibromyalgia,chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination,including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic cooperation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment,addressing the topic from a practical point of view.
基金Supported by grants from Vstra Gtalandsregionen (proj No 07), Dagmar (proj No 643-2000-19) and the University of Gothenburg, Sweden
文摘AIM: To compare irritable bowel syndrome (IBS) pa- tients with apparently healthy persons and to evaluate body awareness therapy, which is a physiotherapeutic remedy focusing on normalising tensions in the body, for the treatment of IBS with the hypothesis that altered body tension is associated with the syndrome. METHODS: Twenty-one IBS patients received body awareness therapy two hours weekly for 24 wk. At base- line as well as after 12 and 24 wk, they underwent ex- aminations including resource oriented body examination in combination with body awareness scale evaluation and f illed in gastrointestinal and psychological symptom questionnaires. Saliva cortisol was analysed. A group of 21 apparently healthy persons underwent the same ex- aminations once. RESULTS: Compared to the apparently healthy group, IBS patients scored higher at baseline for gastrointestinal and psychological symptoms. They showed more often alterations in normal body tension patterns, as well as deviating cortisol slopes in saliva. After 24 wk of body awareness therapy, their gastrointestinal and psychologi- cal symptoms were reduced overall. Somatic symptoms decreased in parallel with depressive symptoms. Whole body pain score decreased, coping ability as well as bio- chemical stress markers improved. CONCLUSION: IBS patients scored higher for gastroin- testinal and psychological symptoms, and presented with altered biochemical stress markers. Their body tension deviated compared to healthy controls. Furthermore,body awareness therapy gave relief of both somatic com- plaints, psychological symptoms and normalised body tension. These findings indicate that distorted tension constitutes an important part of the symptoms in IBS.
